不同吸痰方式对呼吸机相关性肺炎影响的meta分析

Influence of tracheal suction systems on ventilator-associated pneumonia:a meta-analysis

目的评价不同吸痰方式对机械通气患者呼吸机相关性肺炎(VAP)的影响。方法计算机检索中国期刊全文数据库(CNKI)、万方数据库、中国生物医学文献服务系统(CBM)、MEDLINE、The Cochrane Library、EMbase、Web of Scicece、dynamed、The Joanna Briggs Institute Library数据库中关于不同吸痰方式对机械通气患者VAP影响的随机对照试验,由2名研究者按照文献的纳入标准和排出标准进行文献筛选,并对文献进行质量评价,最后应用RevMan 5.2软件对数据进行分析。结果共纳入9篇RCT,共1613例患者。Meta分析结果显示,密闭式吸痰与开放式吸痰在发生VAP[OR=0.75,95%CI=(0.59,0.97),P<0.05]、机械通气时间方面[MD=0.66,95%CI(0.28,1.04),P<0.01]存在统计学差异,在患者病死率方面无统计学差异[OR=0.94,95%CI(0.72,1.22),P>0.05]。结论密闭式吸痰与开放式吸痰相比能预防VAP的发生,降低患者的机械通气时间,但不能降低患者的病死率。

OBJECTIVE To evaluate the influence of different tracheal suction systems on ventilator-associated pneumonia（VAP）in patients undergoing mechanical ventilation.METHODS The randomized controlled trials with the respect to the influence of the tracheal suction systems on VAP were retrieved from CNKI,Wanfang,CBM,MEDLINE the Cochrane Library,EMbase,Web of Scicece,dynamed and the Joanna Briggs Institute Library,the literatures were screened by 2 researchers based on the inclusion and exclusion criteria of literatures,the quality of the eligible literatures was evaluated,and the data were analyzed by using RevMan 5.2 software.RESULTS Totally9 literatures relating to RCT were included,with 1613 patients involved.The result of the meta-analysis showed that there was significant difference in the incidence of VAP [OR=0.75,95%CI=（0.59,0.97）,P〈0.05]or mechanical ventilation duration[MD=0.66,95%CI（0.28,1.04）,P〈0.01]between the patients receiving closed tracheal suction and the patients receiving open tracheal suction,but there was no significant difference in the mortality rate[OR=0.94,95%CI（0.72,1.22）,P〉0.05].CONCLUSIONCompared with the open tracheal suction system,the closed tracheal suction system may prevent the VAP and shorten the mechanical ventilation duration but can not reduce the mortality rate.